Psychology and Medicare or Health Fund Rebates

8 easy steps to claiming medicare benefits on psychology sessions

Step 1. Decide you need to see a psychologist

You have been feeling bad, sad, mad or really stressed out for long enough and you decide you want to get some help. OR maybe your doctor, a friend or another health professional has suggested you 'see someone'.

Step 2. Decide if you want to use medicare

You decide that "someone" is a registered psychologist who is eligible to provide medicare funded sessions.and either...a. You want to be able to get medicare rebates for your sessions*. b. You don't want to use medicare rebates (scroll down to private health fund information).

Medicare option : You will need a referral letter that relates to a "Mental Health Care Plan" MHCP

Step 3. Decide who will issue your referral

You can get the referral from a

General Practitioner / Local Doctor

Paediatrician

Psychiatrist

Step 4. Book an appointment to get the referral

You will need to book a double session with the GP as the mental health care plan takes a little longer than the standard consultation. Just tell the receptionist you need to get a MHCP (mental health care plan) when you book in. He/she will know exactly what you are talking about as this is a very common appointment.

Step 5. Attend the referral appointment for assessment

Visit your GP. Ideally it is your regular GP who knows you well enough and that you are experiencing difficulty justifying the referral. If not, that is ok, some people prefer not to see their family doctor for referral to a psychologist. If this is you then the next best option is to see another doctor at your usual practice.

The doctor will want to know what you are feeling and has a checklist of questions they need to go through, they may also get you to do a short questionnaire. You don't need to tell your doctor all the details of your situation - save that for your psychologist:) All your doctor needs to know is that you have symptoms and are experiencing distress. They have to put you in a category of a mental disorder. However, you don't have to be mentally ill, suffering greatly or at the point of giving up. The whole idea is that you get help before you feel this bad. The most common referrals are for depression or anxiety, and trust me, a lot of people have this so it is nothing to be ashamed of.

Step 6 Take the referral letter to your psychologist on or before the first session you want to claim

You will leave your doctors with a letter and copy of the MHCP. You only need to give the letter to your psychologist, however, they might need to see the plan to know what the doctor has recommended.

6a. Enjoy the relief of talking to your psychologist

7. Pay the psychologist and get the rebate

Like most doctors, most psychologists also charge more than the medicare rebate so you will have a 'gap' payment. To get your medicare rebate you will either;

Present your referral letter to the psychologist pay the full fee and the psychologist will give you a receipt with details necessary to lodge with medicare.

Alternately your psychologist might have an Eftpos machine or another application that processes the claim for you so you. In this instance you will pay the full fee but the rebate will be processed into your account immediately.

Focused psychological strategies for +50 minutes is medicare (MBS) item number 80110 and attracts a rebate of $84.80Clarissa's fee is currently set at $170 per hour which means you pay only $85.20 out of pocket and will receive $84.80 back from medicare.

Your referral lasts 1 year from the date you received it and the MHCP was done. So, if you saw your doctor on 3 October 2014, your referral lasts until 2 October 2015. You are eligible for up to 10 visits/ rebates per calendar year for individual sessions and another 10 for group sessions (see rebate form above)However, your initial referral will be for 6 sessions, after 6 sessions your psychologist will need to let your doctor know how you are going and if you need the other 4. Then your doctor will lodge a review item number (and you don't necessarily have to go in for another GP session to do this) and your plan is active for another 4 rebates.

Your referral lasts a year, but your sessions 'reset' at the end of the year. So each year you can access 10 sessions.

Example 1. Dianna was experiencing significant depression following her divorce and the death of her mother. She got her MHCP on 3 October and saw her psychologist every week until December 14 totalling 10 sessions (6 plus a review where she was issued another 4). On the 1 of January her eligible sessions for the year reset to 10 again. She didn't need to see her GP as her referral was still valid so she began seeing her psychologist again in January and continued seeing her for another 6 sessions. She was feeling much better but still needed some support. Her GP approved an additional 4 session which she spread out over the next few months. Dianna's annual allowance of 10 sessions was used up by May. She was doing very well but wanted to have a check in appointment with her psychologist every month or so. However, her medicare rebates for the calendar year were all used up (for individual sessions) so she began using her health fund cover to supplement the cost of her ongoing sessions.

Example 2. Dianna used all her 10 sessions before christmas. The next year her sessions reset but she felt she only needed to see her psychologist every two months. From January to October she used another 5 sessions. She needed to return to her GP on October 2 to get a new mental health care plan referral to access the remaining 1 session out of the initial 6 available. Following the 6th session her psychologist contacted her GP to get the review item number lodged so she could access another 4. Another crises had occurred in her life and her depression was returning. After the following 4 sessions she had used her allotted 10 sessions for the year and then was able to access rebates from her private health fund.

The information on private health fund use is not so clear but I will do my best to outline it.

1. You will likely need to have the top cover plans of your health fund, so check your premium.

2. You need to choose if you are going to use your health fund or medicare. You can't use both at the same time.

3. If you have had a mental health care plan prepared you are obligated to use all medicare funding before you can access private health fund rebates.

You can't use both medicare and health fund rebates at the same time. Having an active mental health care plan (so one prepared in the last year) means you have to use these benefits first. Once you have used all medicare offers (10 sessions) then you can use your health fund.

4. If you have chosen not to have a mental health care plan issued you can use your private health care fund benefits immediately.

5. If you are not an Australian resident and do not have a medicare card then you will need non-resident private health cover to act in place of medicare.

Example Private Health Fund rebates for Australian Residents*Please check with your health fund to confirm your actual eligibility and rate of refund below are only examples.

Medical Cover option If the psychologist lists MBS item number on the invoice (e.g. 80110), it will come under Standard Medical Cover. Under this, you are covered 100% of the MBS ($99.75- see document above for item 80110) charge. Anything charged above this will be your out of pocket. If psychologist fee is $170 your our of pocket cost will be $85.25.

Extras OptionIf you provider does not list an MBS item number, then it will be billed under the Clinical Psychology portion of your Value Benefits. For this you are covered 80% of the consultation cost, up to your maximum limit of $600 per person, per membership year. Please note, these limits are combined with Dietetics, Hypnotherapy and Natural Therapies.

Frequently asked questions about medicare and psychology

Does the mental health care plan go on my medical record? Yes it does, you will need to talk with your doctor about what is recorded and the limits of it's confidentiality and any other ramifications you might be concerned about.

Will having a mental health care plan mean I have to be diagnosed as having a mental health problem?Yes, it will. The mental health care plan is based on you GP diagnosing some sort of mental health issue and these are listed below. Most common are depression, anxiety or an adjustment disorder.

How much information will you give my doctor about my treatmentAs little as possible. The details of your sessions are confidential. All I need to do is, at the end of 6 sessions, report to your doctor on how you are going in general if there is a need for another 4. The details of your sessions are not available to medicare, your doctor, or your health fund. They are confidential saving very extreme circumstances. See my document (Forms page) on the limits of confidentiality.

I tried to claim my session from medicare but it didn't work, what happened? Once you have paid for the consultation with your doctor, they "bill" the session with an item number (usually 2701 or similar) this important step activates your plan with medicare. If, for some reason your MHCP session was not billed yet (you are trying to claim too soon), or billed with the wrong item number then medicare won't recognise you have an active plan.

6.4 If a claim for a GP Mental Health Treatment Plan has not been processed by Medicare Australia first then the Medicare system will not recognise the patient as being eligible for a rebate in relation to the referred services. In this case, the patient (or patient's GP, if the item is being direct billed to Medicare Australia) should take steps to have the GP Mental Health Treatment Plan item claimed prior to submitting (or resubmitting) the claim for the referred service/s. Note that the date of the referred service/s must be on or after the date the GP Mental Health Treatment Plan was provided. https://www.health.gov.au/internet/main/publishing.nsf/Content/pacd-gp-mental-health-care-pdf-qa#1_3

Does medicare get to know details about my sessions with the psychologist?No, Medicare doesn't see your plan or any of the details of your GP session, they just get a number and that number will come up when you go to claim a rebate on a session. Medicare will never see the details of your private sessions with the psychologist. These notes are kept confidential.

What mental health problems can be treated under the Better Access initiative?'Mental disorder' is a term used to describe a range of clinically diagnosable disorders that significantly impact on a person's emotions, thoughts, social skills and decision-making. The Better Access initiative covers people with mental disorders arising from: